Cervical cancer develops in the cells lining the cervix — the lower part of the uterus that connects to the vagina. It is the second most common cancer in Indian women and the leading cause of cancer death in women in many parts of India, primarily because access to routine screening remains limited. The great irony is that cervical cancer is one of the most preventable cancers: the vast majority of cases are caused by persistent infection with high-risk strains of Human Papillomavirus (HPV), against which effective vaccines exist, and which can be detected years before cancer develops through Pap smear or HPV testing.
Dr. Nishtha Tripathi Patel is an ESGO-2026–certified Gynecological Oncosurgeon in Ahmedabad who manages the full spectrum of cervical cancer — from early-stage surgical treatment to fertility-sparing procedures (trachelectomy) and coordination of chemoradiotherapy for advanced disease.
Trust Signals
- Specialty: Gynecologic Oncology
Types of Cervical Cancer
Cervical cancers are classified by cell type:
- Squamous cell carcinoma — accounts for 70–80% of cervical cancers. Originates in the squamous cells covering the outer surface of the cervix. Strongly associated with HPV 16 and 18.
- Adenocarcinoma — develops from mucus-producing gland cells in the endocervical canal. Accounts for 20–25% of cases and is increasing in younger women. Slightly harder to detect on Pap smear; HPV testing is particularly important.
- Adenosquamous carcinoma — contains features of both types; accounts for a small proportion of cases.
- Neuroendocrine cervical cancer — rare, aggressive subtype that often presents at an advanced stage and requires specialised treatment. Strongly associated with HPV 18.
Risk Factors
The primary cause of cervical cancer is persistent infection with high-risk HPV strains, particularly HPV 16 and 18. Additional factors that increase risk include:
- No or infrequent cervical screening — the single most significant risk factor in the Indian context. Most women diagnosed with invasive cervical cancer have never had a Pap smear.
- Multiple sexual partners or early sexual debut — increases likelihood of HPV exposure.
- Immunosuppression — HIV infection, organ transplant recipients, and long-term corticosteroid use impair HPV clearance.
- Cigarette smoking — doubles the risk of squamous cell cervical cancer by impairing local immune surveillance.
- Long-term oral contraceptive use — associated with a modest increase in risk of adenocarcinoma.
- High parity — multiple full-term pregnancies are independently associated with increased risk.
- No HPV vaccination — unvaccinated women remain fully susceptible to HPV 16 and 18, which together cause ~70% of cervical cancers.
Symptoms
Early cervical cancer and pre-cancerous changes (CIN) typically cause no symptoms — which is precisely why screening is so important. When symptoms do appear, they may include:
- Abnormal vaginal bleeding — between periods, after menopause, or after sexual intercourse (post-coital bleeding is a classic warning sign)
- Unusual or malodorous vaginal discharge
- Pelvic pain or lower back pain
- Pain during sexual intercourse
- Leg swelling or pain (may indicate advanced disease with lymph node involvement)
- Difficulty urinating or blood in urine (may indicate bladder involvement)
- Rectal bleeding or change in bowel habits (may indicate rectal involvement)
Any postmenopausal bleeding or persistent post-coital bleeding should be investigated promptly regardless of recent normal smear results.
Screening and Diagnosis
Cervical cancer is unique among gynaecological cancers in having well-validated screening tools that detect pre-cancerous changes years before invasion occurs.
- Pap smear (cervical cytology) — samples cells from the transformation zone of the cervix. Recommended every 3 years from age 21 (or within 3 years of first sexual activity). Abnormal results are classified by the Bethesda System (LSIL, HSIL, ASC-US, etc.).
- HPV DNA testing — more sensitive than Pap smear for detecting high-grade CIN. Recommended as a co-test with Pap smear every 5 years for women aged 30–65, or as primary screening every 5 years from age 25.
- Colposcopy — magnified visual examination of the cervix, performed when Pap smear or HPV test is abnormal. Allows targeted biopsy of suspicious areas.
- Cervical biopsy (punch or cone) — definitive tissue diagnosis. Cone biopsy (LLETZ/LEEP or cold knife cone) removes a cone-shaped portion of the cervix for histopathological examination and can be both diagnostic and therapeutic for CIN.
- MRI pelvis — gold standard for local staging: assesses parametrial invasion, tumour size, and bladder/rectal involvement.
- PET-CT — assesses nodal involvement and distant metastasis.
Staging (FIGO 2018)
Cervical cancer is staged clinically using the FIGO 2018 system, which now incorporates imaging and pathological lymph node assessment:
- Stage I — Confined to the cervix
- IA1: Microscopic invasion ≤3 mm depth
- IA2: Microscopic invasion >3 mm but ≤5 mm depth
- IB1: Tumour ≤2 cm in greatest dimension
- IB2: Tumour >2 cm and ≤4 cm
- IB3: Tumour >4 cm
- Stage II — Beyond cervix but not to pelvic sidewall or lower third of vagina
- IIA: Involvement of upper 2/3 of vagina without parametrial invasion
- IIB: Parametrial involvement (not reaching pelvic sidewall)
- Stage III — Extension to pelvic sidewall, lower vagina, or causing hydronephrosis; or lymph node involvement
- IIIA: Involvement of lower third of vagina
- IIIB: Pelvic sidewall extension or hydronephrosis
- IIIC1: Pelvic lymph node metastasis only
- IIIC2: Para-aortic lymph node metastasis
- Stage IV — Beyond true pelvis or involvement of bladder/rectal mucosa
- IVA: Spread to adjacent organs (bladder, rectum)
- IVB: Distant metastasis
Treatment
Treatment depends on stage, tumour size, lymph node status, and whether fertility preservation is desired.
- LLETZ / LEEP or cold-knife conisation — for CIN 2/3 (pre-cancer) and Stage IA1 without lymphovascular invasion. Cures CIN in over 90% of cases.
- Simple or modified radical hysterectomy — for Stage IA1 with LVSI and Stage IA2. Lymph node assessment with sentinel lymph node biopsy or pelvic lymphadenectomy is recommended.
- Radical hysterectomy (Type C) with pelvic lymphadenectomy — gold standard surgical treatment for Stage IB1, IB2, and selected IIA1 tumours. Removes the uterus, cervix, upper vagina, parametria, and pelvic lymph nodes. Dr. Nishtha performs minimally invasive (laparoscopic) radical hysterectomy for appropriately selected tumours ≤2 cm per LACC trial criteria.
- Radical trachelectomy — fertility-sparing surgery for carefully selected patients with Stage IA2 or IB1 tumours ≤2 cm who wish to preserve their uterus. The cervix is removed while leaving the uterine body in place. Dr. Nishtha has performed trachelectomies in young women with early cervical cancer.
- Concurrent chemoradiotherapy (CCRT) — standard treatment for Stage IIB and above, and for Stage IB3/IIA2 tumours too large for primary surgery. Combines external beam radiotherapy (EBRT) with weekly cisplatin chemotherapy, followed by brachytherapy (intracavitary radiation). Equivalent or superior survival to surgery for locally advanced disease.
- Bevacizumab + chemotherapy — for recurrent or metastatic disease; GOG-240 trial showed improved survival with the addition of bevacizumab to platinum-based chemotherapy.
- Pembrolizumab (immunotherapy) — for PD-L1–positive recurrent/metastatic cervical cancer; now incorporated into first-line treatment for advanced disease.
Cervical Cancer Care in Ahmedabad
Dr. Nishtha Tripathi Patel provides ESGO-certified surgical management of cervical cancer at Sterling Hospitals (Sindhubhavan Road) and KD Hospital (Bopal), Ahmedabad. For early-stage disease, minimally invasive radical hysterectomy and fertility-sparing trachelectomy are offered for appropriately selected patients. For patients requiring chemoradiotherapy, Dr. Nishtha coordinates the multi-disciplinary oncology plan with radiation oncologists and medical oncologists at partner institutions.
Women from Surat, Vadodara, Rajkot, Bhavnagar, and across Gujarat can access specialist cervical cancer evaluation in Ahmedabad. For patients with an existing biopsy result, a remote report review can be arranged before the initial visit to streamline the consultation.
Treatment planning is guided by Dr. Nishtha Tripathi Patel, Consultant Gynecological Oncosurgeon in Ahmedabad.
Consultation available in Ahmedabad, Surat, Vadodara, and Gandhinagar.
Frequently Asked Questions
- Can cervical cancer be prevented?
Yes — to a significant extent. HPV vaccination prevents infection with HPV 16 and 18 (responsible for ~70% of cervical cancers) and is most effective when given before first sexual exposure. Gardasil 9 protects against 9 HPV strains and is now recommended for girls and boys from age 9–14 (and up to age 26 for women not previously vaccinated). Regular cervical screening (Pap smear and/or HPV testing) detects pre-cancerous changes (CIN) that can be treated before cancer develops. Women who are vaccinated AND screened regularly have the lowest risk of developing cervical cancer.
- What does an abnormal Pap smear mean?
An abnormal Pap smear does not mean you have cancer — in the vast majority of cases it indicates pre-cancerous cellular changes (CIN 1, 2, or 3) or an HPV infection. The degree of abnormality determines the next step: mild changes (LSIL / CIN 1) are often watched with repeat testing since many resolve spontaneously; moderate or severe changes (HSIL / CIN 2–3) are referred for colposcopy and possible LLETZ treatment. An abnormal result always warrants further evaluation by a gynaecologist — it should not be ignored, but it should not cause immediate alarm either.
- Is fertility preservation possible after a cervical cancer diagnosis?
For carefully selected women with early-stage cervical cancer (Stage IA2 or IB1 with tumours ≤2 cm and no lymph node involvement), radical trachelectomy — removal of the cervix while preserving the uterus — is a validated fertility-sparing option. The procedure allows future pregnancy through IVF or natural conception with cerclage support. Pregnancy rates after trachelectomy are approximately 50–70% with IVF. Dr. Nishtha has experience with trachelectomy and can assess whether it is appropriate based on tumour size, histology, and individual circumstances.
- What is the difference between LEEP/LLETZ and a hysterectomy for cervical cancer?
LEEP (Loop Electrosurgical Excision Procedure) or LLETZ (Large Loop Excision of the Transformation Zone) removes a small cone-shaped portion of the cervix under local anaesthesia. It is used for pre-cancerous changes (CIN 2/3) and very early microscopic cancer (Stage IA1). A hysterectomy removes the entire uterus and cervix and is required for more advanced early-stage cancers (IA2 and above) where a simple excision is insufficient. The extent of the surgery (simple vs. radical) depends on how far the cancer has spread into the surrounding tissues.
- What is chemoradiotherapy and when is it used?
Concurrent chemoradiotherapy (CCRT) combines external beam radiotherapy (EBRT) to the pelvis with weekly low-dose cisplatin chemotherapy over approximately 5–6 weeks, followed by brachytherapy (internal radiation placed directly in the cervix/vagina). The chemotherapy sensitises cancer cells to radiation, improving local control. CCRT is the standard treatment for Stage IIB and above, and for bulky Stage IB3/IIA2 tumours. For these stages, it achieves equivalent or better survival compared to surgery and avoids the need for a major operation.
- Can I have cervical cancer if I had a normal Pap smear recently?
A normal Pap smear significantly reduces the likelihood of cervical cancer but does not eliminate it entirely. Pap smear sensitivity for high-grade CIN is approximately 55–70%; some cancers, particularly adenocarcinomas arising in the endocervical canal, can be missed on cytology alone. This is why HPV co-testing or primary HPV testing is now recommended — it has higher sensitivity. Additionally, rapidly progressive cancers can occasionally develop in the interval between normal smears. Any persistent symptoms (post-coital bleeding, unusual discharge, pelvic pain) should be evaluated by a gynaecologist regardless of recent screening results.
- Should I get a second opinion for cervical cancer treatment?
Yes — particularly if you have been told you need radical surgery or chemoradiotherapy, or if your tumour is at a borderline stage where either modality might be appropriate. A second opinion from a gynaecological oncologist can confirm staging, review imaging, and ensure the proposed treatment is consistent with current ESGO/NCCN guidelines. Dr. Nishtha offers structured second opinion consultations for patients diagnosed elsewhere, with remote report review available for patients travelling from outside Ahmedabad.